Opportunistic infection at the start of antiretroviral therapy and baseline CD4+ count less than 50 cells/mm3 are associated with poor immunological recovery

Amod Tilak 1 , Smita Shenoy 1 , Muralidhar Varma 2 , Asha Kamath 3 , Amruta Tripathy 4 , Ravi Sori 5  and Kavitha Saravu 6
  • 1 Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • 2 Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • 3 Department of Statistics, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • 4 Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
  • 5 Department of Pharmacology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
  • 6 Department of General Medicine, Kasturba Medical College, Manipal, Manipal McGill Centre for Infectious Diseases (MACID), Manipal Academy of Higher Education, Manipal, Karnataka, India
Amod Tilak
  • Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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, Smita Shenoy
  • Corresponding author
  • Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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, Muralidhar Varma
  • Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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, Asha Kamath
  • Department of Statistics, Manipal Academy of Higher Education, Manipal, Karnataka, India
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, Amruta Tripathy
  • Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
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, Ravi Sori
  • Department of Pharmacology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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and Kavitha Saravu
  • Department of General Medicine, Kasturba Medical College, Manipal, Manipal McGill Centre for Infectious Diseases (MACID), Manipal Academy of Higher Education, Manipal, Karnataka, India
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Abstract

Introduction

There is a dearth of studies assessing the efficacy and immunological improvement in patients started on antiretroviral therapy (ART) in India. This study was undertaken to assess the 2-year treatment outcomes in HIV-positive patients initiated on ART in a tertiary-care hospital.

Methods

After approval from the Institutional Ethics Committee, adult HIV-positive patients from a tertiary-care hospital, initiated on ART between January 2013 and February 2015, were included in the study. Data on clinical and immunological parameters were obtained from medical case records over a period of 2 years after initiation of therapy. Intention-to-treat analysis was done using a descriptive approach, using SPSS version 15 (SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). A logistic regression analysis was done to assess the predictors for poor outcomes. A p-value <0.05 was considered statistically significant.

Results

ART was initiated in 299 adult patients. At 1 and 2 years, the median (interquartile range) change in CD4+ cell count was 65 (39, 98) cells/mm3 and 160 (95, 245) cells/mm3. The change observed after 2 years of treatment initiation was statistically significant compared with that after 1 year. Three deaths occurred during the study period and 28 were lost to follow-up. Male sex, presence of at least one opportunistic infection at the start of therapy, and baseline CD4+ count <50 cells/mm3 were associated with poor immunological recovery.

Conclusions

With long-term treatment and regular follow-up, sustained clinical and immunological outcomes can be obtained in resource-limited settings.

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